Provider Demographics
NPI:1023342706
Name:GAINES, SARAH ELIZABETH (PSYS, NCSP)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:ELIZABETH
Last Name:GAINES
Suffix:
Gender:F
Credentials:PSYS, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 W SPEEDWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-2326
Mailing Address - Country:US
Mailing Address - Phone:520-770-3141
Mailing Address - Fax:520-770-3861
Practice Address - Street 1:1200 W SPEEDWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2326
Practice Address - Country:US
Practice Address - Phone:520-770-3141
Practice Address - Fax:520-770-3861
Is Sole Proprietor?:No
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4036960103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool